tbuckley/cabot-search huggingface dataset:
Abstract 32: Physical Activity Fragmentation and Mortality in Hispanics/Latinos: The Hispanic Community Health Study / Study of Latinos (HCHS/SoL)
Authors: Mauro F Mediano, Yejin Mok, Shoshana Ballew, Franklyn Gonzalez, Daniela Sotres-Alvarez, Yasmin Mossavar-Rahmani, Robert Kaplan, Jordan A Carlson, Sarah Alver, Martha L Daviglus, Olga Garcia-Bedoya, Kelly R Evenson, Jennifer Schrack, Kunihiro Matsushita
Journal: Circulation (2023)

Background: Physical activity (PA) fragmentation, an emerging concept of PA patterns, indicates the frequency of transitioning from an active to a sedentary state. Whether PA fragmentation provides prognostic information beyond conventional PA measures is unclear, especially in Hispanics/Latinos. Aim: To examine the association between PA fragmentation and mortality in Hispanics/Latinos. Methods: We included 9,856 participants (mean age 41.7 [SE 0.27] years; 52.1% women) from HCHS/SOL with baseline PA evaluation from an Actical accelerometer (≥3 days with ≥10 hr/day of wear). We defined sedentary as &lt;10 counts/min and active as ≥10 counts/min. PA fragmentation was calculated using the active-to-sedentary transition probability (ASTP), defined as the reciprocal of the average active bout duration on a minute-level basis across valid days. We used daily mean total log activity counts (TLAC) as a measure of total PA volume. We modeled the residuals of ASTP regressed on TLAC (total-PA-adjusted ASTP) to investigate ASTP independently of total PA. Deaths were identified from annual follow-up contacts until December 31, 2018. We explored multivariable Cox regression models accounting for the multi-stage sampling design. Results: There were 242 deaths (2.5%) over a mean of 7.1 years. ASTP was associated with mortality in all models ( Table ). Each 0.10-unit increase of ASTP at baseline was associated with a 38% higher mortality risk after accounting for demographic, clinical, and lifestyle factors. Similarly, the highest ASTP tertile indicated a 2-times greater risk of death compared to the lowest tertile. The results were largely similar when we modeled using total-PA-adjusted ASTP. Higher TLAC was also associated with reduced mortality. Similar results were observed after excluding early deaths (first 2 years). Conclusion: PA fragmentation was robustly associated with mortality, independent of total PA volume. Our findings support PA fragmentation as an emerging novel measure that is informative beyond total PA.
Abstract P152: Joint Association of Sugar- and Artificially-Sweetened Beverage Consumption and Physical Activity and Risk of Type 2 Diabetes in US Adults
Authors: Lorena S Pacheco, Deirdre K Tobias, Yanping Li, Shilpa N Bhupathiraju, Walter Willett, David S Ludwig, Cara B Ebbeling, Danielle Haslam, Jean-Philippe Drouin-chartier, Frank B Hu, Marta Guasch
Journal: Circulation (2023)

Background: Consumption of sugar-sweetened beverages (SSBs) or artificially sweetened beverages (ASBs) and physical activity are independently associated with type 2 diabetes (T2D) risk; however, it is unknown whether there is an interaction of SSB/ASB intake and physical activity on risk of T2D. Methods: We examined the independent and joint associations between habitual SSB/ASB intake and physical activity with incident T2D risk among 196,101 women and men from the Nurses’ Health Study (NHS, 1980-2016), NHSII (1991-2017), and Health Professional’s Follow-up Study (HPFS, 1986-2016), who were free from chronic diseases at baseline. Cox proportional hazards regressions were used to estimate hazard ratios and 95% confidence intervals (HR; CI), adjusting for demographic and lifestyle T2D risk factors. Results: There were 20,430 incident T2D cases over follow-up of 36, 26, and 30 years in NHS, NHSII, and HPFS, respectively. In multivariable-adjusted models, we confirmed that participants with higher SSBs, ASBs and lower physical activity were independently at higher T2D risk, compared to lower intakes and higher activity levels. In joint analyses for these exposures, participants who did not meet physical activity guidelines and consumed gt 2 servings/day of SSBs had a significantly higher risk of T2D than those who met physical activity guidelines and never/rarely consumed SSBs (1.51; 1.43, 1.60); we observed similar findings for ASBs: 1.29; 1.23, 1.36). Among participants who met physical activity guidelines, those who consumed gt 2 servings/day of SSBs had a HR of 1.23 (1.16, 1.30); the HR for ASBs was 1.07 (1.02, 1.13). Consistent results were observed for women and men. Conclusions: Long-term habitual intake of SSBs or ASBs combined with lower physical activity was associated with higher risk of T2D in three large prospective cohort studies. These findings suggest that even when individuals are physically active, higher consumption of SSBs is associated with a higher risk of T2D. Our results support recommendations and policies to limit the intake of SSB and increase physical activity levels.
Abstract P334: N-terminal Pro B-type Natriuretic Peptide Improves Stratification of Cardiovascular Disease and Specifically Stroke Risk in South Asians
Authors: Ayesha Ahmed, Snehal Pinto Pereira, Therese Tillin, Goya Wannamethee
Journal: Circulation (2023)

Introduction: N-terminal pro B-type natriuretic peptide (NT-proBNP) has been widely explored as a biomarker for improving cardiovascular disease (CVD) risk stratification in populations of European ancestry. Evidence on whether NT-proBNP adds value to CVD risk prediction in South Asians (SA) is limited. Hypothesis: We hypothesized that NT-proBNP would improve CVD and stroke-specific risk stratification in SA. Methods: In the London-based multi-ethnic Southall and Brent Revisited study 1710 first generation SA were randomly recruited from primary care lists and workplaces in 1988-91. Of these, 1149 (mean age 51±7y, 85% men) were free of prevalent CVD and had complete data on baseline CVD risk factors and NT-proBNP (median 31pg/ml, 1 st -3 rd quartile 19-55pg/ml). Follow-up for mortality and fatal/non-fatal coronary heart disease (CHD) and stroke events was available to 2008-11. We assessed change in discrimination (Harrell’s C-index [95% CI]) and integrated discrimination improvement (IDI) on adding standardized log-NT-proBNP to Cox models containing age, sex, body mass index, cholesterol:HDL ratio, systolic blood pressure, antihypertensive use, smoking, diabetes, chronic kidney disease and social class; for predicting (1) risk of composite-CVD (CHD or stroke) over (a) 10y and (b) maximum follow-up of 22y; and (2) risk of stroke over 22y. Net reclassification improvement (NRI) for events (NRIe) and non-events (NRIne) was calculated across high, intermediate and low-risk categories defined by cut-offs corresponding to observed (Kaplan-Meier) risk and half-the-observed risk of each endpoint: CVD 15% and 7.5% over 10y; 44% and 22% over 22y; and stroke 10% and 5% over 22y. Results: Over 10y, 175 SA experienced a first CVD event. NT-proBNP increased C-index from 0.7269 [0.6920-0.7618] to 0.7323 [0.6973-0.7674] with IDI 0.006, NRIe -0.5% and NRIne 3%. Over 22y, 455 participants experienced a first CVD event. NT-proBNP increased C-index from 0.6759 [0.6521-0.6998] to 0.6795 [0.6555-0.7035] with IDI 0.006, NRIe -0.2% and NRIne 2.5%. In both instances, NT-proBNP correctly downgraded 2% of participants without incident CVD from high to intermediate risk with little change in other risk categories. Additionally, 106 participants experienced a first stroke event over 22y. For this model, NT-proBNP increased C-index from 0.7610 [0.7174-0.8046] to 0.7700 [0.7262-0.8138] with IDI 0.018, NRIe 3.8% and NRIne 4.9%. This correctly downgraded 3.5% of participants without incident stroke to low risk. And upgraded 5% of those with incident stroke from intermediate to high risk, while incorrectly downgrading 1% of these participants to low risk. Conclusions: In middle-aged SA, NT-proBNP modestly improves 10y and long-term composite-CVD risk prediction but improves to a greater extent long-term stroke risk prediction leading to sizeable reclassifications into more appropriate risk categories.
Abstract P392: Association Between Blood Pressure Variability and Subclinical Measures of Cardiovascular Disease in Desk Workers
Authors: Joshua Paley, Benjamin Gordon, Abdullah Alansare, Bethany Barone Gibbs
Journal: Circulation (2023)

Introduction: Previous research has demonstrated that variability in resting blood pressure (BP) across arms, measurements, or days may be associated with an increased risk for cardiovascular disease (CVD) and mortality. Yet, the extent to which BP variability increases cardiovascular risk and the mechanisms explaining this association are unclear. This study evaluated associations between BP variability with subclinical pathways of CVD development (arterial stiffness (pulse wave velocity [PWV]) and cardiac autonomic function (heart rate variability [HRV]) in desk workers. Hypothesis: Higher BP variability will be associated with higher PWV and lower (worse) HRV Methods: This secondary analysis of baseline data from the Effect of Reducing Sedentary on Blood Pressure randomized controlled trial included 265 sedentary and inactive desk workers (mean age 44.9±11.6 years; 82.0% white; 57.9% female) with elevated-to-stage 2 hypertension and who were not using antihypertensive medication. Sequential BP measurements determined the arm with the higher systolic BP by using an oscillometric device (Omron HEM-907XL). BP was then measured at least twice from the arm with the higher systolic BP at the first (visit-1) and second (visit-2) visits, occurring ≤30 days apart. Systolic BP variability metrics included inter-arm (first measurements between arms at visit-1), intra-arm (first two measurements on the arm with higher systolic BP at visit-1), and inter-visit (average BP from repeated measurements on the same arm across visits-1 and -2). Subclinical measures of CVD included resting carotid- femoral(cfPWV) and carotid-radial(crPWV) PWV (Complier Analyse) and the log transformed standard deviation of normal R-R intervals (SDNN) and the root mean square of the successive differences (RMSSD) HRV measures (Polar Electro). Adjusted linear regression estimated the associations between subclinical measures of CVD and BP variability metrics; Metrics were operationalized into three categories: differences of 0-5 mmHg, 6-10 mmHg, and 11 or more mmHg. Results: The prevalence of having 6 mmHg or more difference for the inter-arm, intra-arm, and inter-visit systolic BP was 43%, 38%, and 53%, respectively. PWV and HRV were not different across categories of inter-arm systolic BP variability or inter-visit systolic BP variability (all p&gt;0.05). However, a same-day intra-arm difference in systolic BP of 6-10 mmHg within visit-1 was associated with higher cfPWV (β=0.42 m/s, (95% CI: 0.07, 0.77) as compared to those with an intra-arm difference of 0-5 mmHg. Conclusion: These data suggest that higher systolic BP variability in the same arm within visit, but not variability across arms or between visits, may be associated with higher aortic stiffness in desk workers with untreated elevated-to-stage 2 hypertension.
Abstract P190: Social Determinants of Cardiovascular Health in Sexual Minority Adults: A Systematic Review
Authors: Yashika Sharma, Danny Doan, Tonda L Hughes, Billy A Caceres
Journal: Circulation (2023)

Introduction: Sexual minority (e.g., lesbian, gay, bisexual, queer) adults appear to be at higher risk of cardiovascular disease (CVD) than heterosexual adults. Although social determinants of health have been shown to contribute to cardiovascular health (CVH) disparities in the general population, there is a dearth of research examining these determinants in sexual minority adults. Objective: Using the World Health Organization’s definition of social determinants of health, we conducted a systematic literature review to synthesize and critique existing evidence on social determinants of CVH among sexual minority adults. Methods: We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and performed a comprehensive search of literature published between January 2011 and March 2022. Studies were included if they were peer-reviewed, English-language, and examined associations between social determinants of health and CVH outcomes among sexual minority individuals 18 years old or older. CVH outcomes were CVD risk factors (including diabetes, hypertension, hyperlipidemia, and obesity) and CVD conditions (such as stroke, heart attack, and coronary artery disease). We performed quality appraisal using the Joanna Briggs Institute Critical Appraisal Checklists for Analytical Cross-Sectional Studies and Cohort Studies. Results: Our search retrieved 2,133 studies, of which 18 met the inclusion criteria. Of these, 16 were cross-sectional and two used longitudinal designs. All 18 studies had a low risk of bias. The majority (n = 17) included predominantly White samples. Overall, the findings were mixed. Stressful life events were associated with elevated CVD risk. Individuals who reported living in more supportive environments had lower odds of being overweight; however, greater disclosure of sexual minority status was associated with higher odds of being overweight. Living in rural settings was associated with higher odds of obesity and hypertension. Experiences of discrimination were not associated with any CVH outcomes. Findings for interpersonal trauma (e.g., adulthood trauma, childhood trauma), education, religious activity, and relationship status were mixed. No studies examined social determinants at the structural level. Conclusions/Implications: Findings highlight social determinants that may serve as targets of clinical and public health interventions to improve the CVH of sexual minority adults. Future longitudinal research is needed that includes more diverse samples and examines multi-level social determinants of CVH, including at the social and structural levels.
Abstract P244: Gestational Glucose Intolerance is Associated With Hypertensive Disorders of Pregnancy in a Large Hospital-Based Multiethnic Cohort
Authors: Jacqueline Maya, Kaitlyn James, Sarah Hsu, Tanayott Thaweethai, Marie-France Hivert, Camille E Powe
Journal: Circulation (2023)

Introduction: Hypertensive disorders of pregnancy (HDP) are associated with higher future cardiovascular risk. Treatment of gestational diabetes (GDM) has been shown to reduce the risk of HDP. It is unknown if women with gestational glucose intolerance (GGI), defined as abnormal GDM screening but without a GDM diagnosis, are at higher risk of HDP. Currently, GGI is not treated. Hypothesis: We tested the hypothesis that GGI pregnancies have increased odds of HDP. Methods: This is a retrospective cohort study of 41,706 singleton pregnancies delivered at an academic center. Based on the results of GDM screening and diagnostic tests, pregnancies were categorized as normal glucose tolerance (NGT, glucose loading test &lt; 140 mg/dl), GGI (glucose loading test ≥140 mg/dl with 0 or 1 abnormal value on oral glucose tolerance testing [OGTT] thus without GDM), or GDM (≥ 2 abnormal values on OGTT). GGI was further classified into groups with zero (GGI-0) or 1 (GGI-1) abnormal OGTT values. We used laboratory, blood pressure, and delivery reports to capture HDP and exclude chronic hypertension. Generalized estimating equations for logistic regression were used to measure the risk of HDP after adjustment for age, 1st trimester BMI, parity, insurance, race/ethnicity, and marital status. A similar approach was used to test for associations between GGI and pre-eclampsia (PE). Results: A total of 84.5% of pregnancies were classified as NGT, 8.9% as GGI-0, 3.0% as GGI-1 and 3.6% as GDM. The unadjusted frequencies of HDP and PE were higher in GGI-1 (140 [11.2%] and 64 [5.1%] of 1,251) and GDM (165 [11.1%] and 94 [6.3%] of 1,485) compared to NGT (2,275 [6.5%] and 1,100 [3.1%] of 35,238) and GGI-0 (283 [7.6%] and 136 [3.6%] of 3,732). We observed greater odds of HDP in all 3 groups compared to NGT in adjusted models, and similar trends for PE (Figure 1). Conclusions: The risks of HDP and PE in GGI-1 are greater than for NGT pregnancies and similar to the risks in GDM. Our results suggest that women with GGI-1 should be considered for intervention, similar to GDM.
Abstract P451: Coronary Artery Calcium and the Association Between Dietary Fish Intake and Atherosclerotic Cardiovascular Disease Risk
Authors: Alexander C Razavi, Abdulhamied Alfaddagh, Omar Dzaye, Matthew J Budoff, Paul Whelton, Tanika N Kelly, Jiang He, Lydia A Bazzano, Camilo Fernandez, Timothy Harlan, Alanna A Morris, Arshed A Quyyumi, Roger S Blumenthal, Michael J Blaha, Laurence Sperling, Seamus P Whelton
Journal: Circulation (2023)

Introduction: Current guidelines recommend ≥2 servings of fish/week for the prevention of atherosclerotic cardiovascular disease (ASCVD). However, a recent large meta-analysis suggested that the benefit may exist only for persons with a prior ASCVD event. Whether coronary artery calcium (CAC) can help to identify individuals who are likely to benefit from habitual fish consumption is unknown. Hypothesis: CAC will stratify persons who may and may not benefit from habitual fish consumption. Methods: There were 4977 participants in the Multi-Ethnic Study of Atherosclerosis who reported their frequency of fish intake and underwent CAC scanning at Visit 1. Adjusted Cox proportional hazards regression models stratified by the presence/absence of CAC assessed the association between fish intake and incident ASCVD over a median follow-up of 15.7 years. Results: The mean age was 61 years old, 53% were women, 26% were Black, and 49% of participants had prevalent CAC. A similar proportion of individuals reported consuming ≥2 servings of fish/week for those with CAC=0 and CAC &gt;0 (35% versus 33%, p=0.12). The absolute ASCVD event rate for those with &lt;2 or ≥2 servings of fish/week was 5.5 vs. 4.2 per 1,000 person-years for CAC=0 and 18.2 vs. 19.0 person-years for CAC &gt;0 (Figure 1). Each additional serving of fish/week was associated with a 9% lower risk of ASCVD for participants with CAC=0 (HR=0.91, 95% CI: 0.83-0.99) whereas there was no significant association for persons with CAC &gt;0 (HR=1.03, 95% CI: 0.99-1.07). Conclusions: A higher amount of fish consumption was associated with a lower risk of incident ASCVD for participants with CAC=0, but not those with CAC &gt;0, although the absolute ASCVD event rate was low for persons with CAC=0 regardless of fish consumption frequency.
Abstract 44: Plasma Sphingolipids in Relation to Cognitive Decline and Incident Dementia
Authors: Kristine F Moseholm, Héléne Cronje, Annette L Fitzpatrick, Lewis H Kuller, Oscar L Lopez, Marcia D Otto, W T Longstreth, Andy Hoofnagle, Ken J Mukamal, Rozenn N Lemaitre, Majken K Jensen
Journal: Circulation (2023)

Introduction: Sphingolipids are fundamental components of brain structure and function. They are located in the myelin sheath insulating neuronal axons and in the cell membranes of neurons, astrocytes, and microglia involved in signal transduction. Although circulating sphingolipid profiles reflect clinical neurodegeneration, few prospective studies have investigated their utility as pre-clinical risk markers in community-based cohorts. For heart disease and diabetes, themselves risk factors for dementia, associations with sphingolipids differed across species and the length of the saturated fatty acid carried. Hypothesis: We hypothesized that plasma levels of sphingolipid species containing palmitic acid (16:0) would be positively associated with incident dementia risk and cognitive decline, while those with arachidic acid (20:0), behenic acid (22:0), and lignoceric acid (24:0) would be associated with lower risk. Methods: We measured 18 sphingolipid species in plasma samples from 4612 participants of the Cardiovascular Health Study (CHS) (mean age 76.2 years; 40% male; and 25% APOE ε4 allele carriers). Cognitive decline was assessed across 6 years using annual 100-point modified Mini-Mental State Examination (3MSE) and Digital Symbol Substitution Test (DSST) scores. A total of 3088 non-demented participants were enrolled in the CHS Cognition Study and followed with adjudication for dementia. To correct the analyses for multiple comparisons, we applied a false discovery rate (FDR) correction and used a significance threshold of 0.05. Results: Higher baseline levels of lactosylceramide-24:0 (LacCer-24) were associated with a faster 6-year cognitive decline (time x sphingolipid interaction p=0.04 for 3MSE and 0.03 for DSST). Conversely, higher baseline plasma levels of hexosylceramide -16:0 (HexCer-16) and sphingomyelin-22:0 (SM-22) were associated with slower cognitive decline measured with DSST (time x sphingolipid interaction p=0.02 for HexCer and p=0.05 for SM-22). During a median follow-up of 4.5 years, we identified 366 incident dementia cases. In proportional Cox regression analyses, higher plasma levels of ceramide-16:0 (Cer-16) were positively associated with incident dementia upon adjustment for demographics, lifestyle factors, medical history, C-reactive protein, and lipids [hazard ratio per SD: 1.18 (95% CI, 1.06; 1.31)]. Conclusions: In older adults without dementia, higher plasma levels of Cer-16, a species previously associated with cardiovascular disease and mortality, were associated with higher risk of clinical dementia as we hypothesized. LacCer-24 was associated with faster, and HexCer-16 and SM-22 with slower, cognitive decline, but these species were not statistically associated with dementia risk. These novel and inconsistent findings will need to be replicated in other longitudinal studies.